tbuckley/cabot-search huggingface dataset:
Racial disparities in access to prescription medications among American patients with cancer.
Authors: Manav Dev Midha, Mark Edward Votruba
Journal: Journal of Clinical Oncology (2022)

173 Background: Though the associations between Black race and increased rates of financial toxicity, as well as Black race and reduced cancer survival, are well-established, further exploration of the mechanisms connecting these two phenomena is required. One channel that has not yet been explored regards access to necessary medications. Cancer may cause financial toxicity, which in turn may reduce patients’ abilities to obtain their required medications, further exacerbating the quantity and/or intensity of medical conditions. In this study, we investigate self-reported access to prescribed medications in the ten cancers with greatest incidence in the United States, regressing on Black race while controlling for covariates. Methods: From the National Health Interview Survey (NHIS) from 2000 – 2020, we extracted data on Breast, Prostate, Lung, Colon, Melanoma, Bladder, Lymphoma, Kidney, Uterine, and Pancreatic cancers. The key outcome measure of financial toxicity used was the NHIS entry “needed but couldn’t afford prescription medicines, past 12 months,” a dichotomous variable. Multivariable logistic regressions on being Black (with reference variable White), controlling for sex (except for in Prostate and Uterine cancers), age first diagnosed with the cancer of interest, having an undergraduate degree, United States citizenship, having annual income greater than $50,000, having health insurance, and year of survey, were run in RStudio (Version 2021.09.1), separately for each cancer. Alpha was set at p &lt; 0.05. Results: In the following six cancers, Black individuals were significantly more likely to not have been able to afford a needed prescription medicine in the last 12 months: Breast (OR = 2.05, p &lt; 0.001, n = 7328), Prostate (OR = 2.91, p &lt; 0.001, n = 4782), Colon (OR = 2.21, p &lt; 0.001, n = 2330), Melanoma (OR = 6.58, p &lt; 0.001, n = 2780), Lymphoma (OR = 2.29, p = 0.004, n = 1202), and Uterine (OR = 1.66, p = 0.030, n = 1640). Conclusions: Financial toxicity-induced disparities in access to prescription medications permeate six of the ten most common cancers in the United States. Given the self-reinforcing feedback loop nature of cancer-related financial toxicity, missing needed medications, and economic standing, particularly for Black patients, there is an urgent need for public investment in programs targeted at increasing prescription medication access. Such policies could substantially reduce racial disparities in American oncology. Future research should include additional biological covariates (such as disease severity) and further address the social determinants of health.
Oncologist and primary care provider attitudes towards shared care in patients with cancer with chronic medical comorbidities.
Authors: Kristen Simmons, Aparna Chakravarti Jotwani, Colbert Parker, Ellen Xiang, Lee Lu, Martha P. Mims, Hoda Badr
Journal: Journal of Clinical Oncology (2022)

35 Background: Medical comorbidities pose challenges to the delivery of quality cancer care. Underserved cancer patients have the highest burden of chronic comorbidities, with increased risk for worse outcomes. Their health outcomes and care transitions might be improved by enhancing collaboration between oncologists and primary care providers (PCPs). Methods: This is a cross-sectional study of oncologists and PCPs in a large public safety-net hospital system in Houston, TX. Providers completed electronic surveys assessing demographics, attitudes, and satisfaction regarding the shared care of cancer patients with chronic comorbidities. Results: Eighteen oncologists (39% minority, 72% female) and 25 PCPs (23% minority, 77% female) completed the surveys. Independent samples t-tests revealed both oncologists and PCPs reported moderate levels of interprofessional collaboration, felt that existing processes to facilitate coordination of care were inadequate, and expressed moderate levels of dissatisfaction with the management of cancer patients with comorbidities within HHS (all p-values = n.s.). However, their attitudes toward care coordination differed significantly depending on the nature and timing of the care being provided. With regard to side effect management during cancer-directed therapy, 81% of PCPs preferred to co-manage side effects with oncologists, but 100% of oncologists preferred to be responsible for this activity (χ 2 = 23.08, p &lt;.001). With regard to management of late-effects of cancer treatment, 40% of oncologists were either interested in co-managing late effects with PCPs or having PCPs be solely responsible for this activity. Conversely, 86% of PCPs preferred to co-manage late effects with oncologists (χ 2 = 26.74, p &lt;.001). For cancer surveillance, oncologists and PCPs expressed interest in sharing responsibility depending on the patient’s risk for recurrence (χ 2 = 1.62, p =.30). Conclusions: Oncologists and PCPs were similarly dissatisfied with comorbidity management in cancer patients, but differed in their attitudes towards care coordination. Oncologists were more resistant to sharing responsibilities of toxicities during and after treatment. They were more accepting of PCPs assuming follow-up care for lower-risk patients. Further investigation is needed to determine specific areas of care coordination, barriers to provider collaboration, and knowledge and processes for effective shared care.
Feasibility of large scale distress screening at an academic center and associated network sites using an adapted patient-reported outcome instrument and reflexive suicide screening.
Authors: Divya Myadam Gupta, Vikashini Savadamuthu, FeiFei Qin, Mohana Roy, Jason Blake Herring, Ashley Robinson, Catherine Terrell, Joel W. Neal, Sheila Lahijani, Kavitha Ramchandran
Journal: Journal of Clinical Oncology (2022)

278 Background: Regular distress screening of patients with cancer is mandated by cancer care guidelines, with 25-50% of patients with cancer experiencing some level of distress. The COVID-19 pandemic amplified symptoms of distress and shifted oncologic care delivery towards telemedicine. In light of challenges faced with implementation of such screening, especially during this pandemic, we sought to assess the feasibility of implementing patient-focused distress screening at a large academic cancer center and its associated network sites. Methods: We designed a modified distress screening tool with reflexive suicidality and mental health screening consisting of 1) Wellness Reflection, a questionnaire that incorporates questions from Patient-Reported Outcomes Measurement Information System-Global Health (PROMIS-GH) to monitor patients’ physical, mental, and social health and to assess patients’ needs for extra support, and 2) modified Patient Health Questionnaire 2+9 (PHQ 2+9) tool to screen for depression and suicide risk. This tool was used to triage patients in need of further assessment by the clinical team, including consideration for referrals to cancer supportive services. The two-tiered distress screening tool was delivered to patients at Stanford Cancer Center and 5 affiliate sites for in-person clinic visits starting September 2019. The Wellness Reflection was launched starting June 2020 for video visits. Results: From October 1, 2019 to May 14, 2021, 147,165 questionnaires representing 46,341 patients were collected. The overall Wellness Reflection questionnaire response rate was 55%; the video visit questionnaire response rate was ̃70%, higher than the in-person visit response rate of ̃50%. About 6% of questionnaires analyzed showed a request for more support, most commonly emotional and physical/symptom support, and this was consistent during the COVID-19 pandemic. 18.6% of questionnaire responses screened positive for further assessment, and those that triggered reflexive suicidality screening had a 17% positive PHQ 2+9 rate. Following assessment, 13,631 referrals to cancer supportive services were generated. Conclusions: The adoption of commonly available patient-reported outcome tools, including PROMIS-GH and PHQ 2+9, as a large-scale distress screening method for both in-person and tele-health clinic visits during the COVID-19 pandemic is feasible at a large academic cancer center and network sites. The volumes of positive screens and referrals were lower than expected despite broader implementation of distress screening and amplified symptoms of distress due to the pandemic.
The association between body composition, quality of life (QoL), overall survival (OS) and decision to treat (DTT) in patients with metastatic non–small cell lung cancer (mNSCLC).
Authors: Hyejung Lee, Ben Haaland, Wallace L. Akerley, Adriana M Coletta, Jeffrey T. Yap, Sonam Puri, Kathleen Claire Kerrigan
Journal: Journal of Clinical Oncology (2022)

377 Background: Among patients diagnosed with mNSCLC, significant declines in fat and muscle mass are common, yet there is a paucity of data related to body composition, QoL, TD, and survival. Accordingly, we evaluated the relationship between body composition via routine CT scans, patient-reported outcomes (PROs), and overall survival (OS) among a convenience sample of mNSCLC patients. Methods: Data from 80 mNSCLC patients with initial CT scans and NCI PROMIS questionnaires within the first three months of diagnosis were analyzed. Body composition from CT scans (sliceOmatic software) extracted Skeletal muscle (SM), intermuscular adipose tissue (IAT), visceral VAT, and subcutaneous (SAT) in area (cm2) and a discovery set was expressed as HU. PROMIS PROs (pain, fatigue, anxiety, depression, and physical function) were collected in clinic using an iPad as an institutional quality initiative. Results: Median time to OS was 16 months. When stratified by sex, females had longer median survival time (female 25 months, male 14 months). When all body composition variables were considered together, greater amounts of skeletal muscle were linked with a 63% reduction in mortality risk 0.37 (95% CI 0.16, 0.87) in the adjusted model. Per one-unit increase in VAT (area cm2) was linked with a 0.04 unit decrease in pain (95% CI -0.08, -0.01). Associations between HU and clinical were also observed. Greater amount of VAT (mean HU) was linked with 2.57(95% CI 1.10, 6.01) times the odds of death in the crude model. Also, in crude model, one unit of increase in skeletal muscle (mean HU) was associated with 0.3 (95% CI 0.03, 0.57) unit increase in physical functionality, and -0.34(95% CI -0.63, -0.05)) unit decrease in fatigue. Conclusions: Body composition data can be collected from retrospective scans and appears to be prognostic of OS, PRO and TD.
Caregiver burden of patients with advanced cancer in Mexico.
Authors: Yanin Chavarri Guerra, Wendy Alicia Ramos-Lopez, Sofía Sánchez-Román, Paulina Quiroz, Alfredo Covarrubias-Gómez, Natasha Alcocer, Andrea Morales Alfaro, María Reneé Jiménez Sotomayor, Roberto Gonzalez Salazar, Araceli Carrillo Bedoya, Ariana Michael Jimenez Cruz, Monica Carrillo, Enrique Soto Pérez de Celis
Journal: Journal of Clinical Oncology (2022)

181 Background: Caregivers of patients with advanced cancer often face significant physical, social, and emotional distress. In many Latin American cultures, family plays a particularly important role in the decision-making process of patients with cancer, and relatives often assume the role of unpaid caregivers. However, there is limited research about the burden associated with cancer unpaid caregiving among patients living in Latin America. We aimed to describe the profile of caregivers and to identify patient-related factors associated with caregiver burden in a third-level cancer center in Mexico City. Methods: We conducted a cross-sectional analysis of baseline data from patients with advanced cancer and their caregivers included in a multidisciplinary patient navigator-led supportive care program in Mexico City ( Te Acompañamos). At the time of enrollment in the program, caregivers completed a short version of the Zarit Burden scale and patients completed a series of screening questionnaires including assessments of quality of life (FACT-G), depression (PHQ-9), and anxiety (GAD-7). Life expectancy was calculated using the palliative performance scale (PPS). We used descriptive statistics, chi-square tests, and multivariate logistic regression analyses to understand which patient factors were associated with higher caregiver burden. Results: A total of 321 patients with advanced cancer (58% women; average age 63.3 +/- 14 years; 32.7 with hepatopancreatobiliary tumors) and 321 caregivers (67.1% women; 44% were the patient’s son/daughter; 29% were their spouses) were included. Sixty-four caregivers (20%) had a high caregiver burden (score &gt; 16 in the Zarit scale). Caregiver burden was more common among the patients’ spouses (24.1 %) followed by brothers/sisters (23.6%). On univariate analysis, moderate/severe levels of depression (p = 0.001), moderate/severe levels of anxiety (p = 0.02), and lower PPS scores (p = 0.002) were associated with a high caregiver´s burden. Multivariate analysis showed that only PPS &lt; 180 days was associated with increased odds of having caregiver burden (2.0; 95% CI 1.8-3.7); p = 0.02). Conclusions: A significant proportion of unpaid caregivers of Mexican patients with advanced cancer report high levels of caregiver burden, and the odds of having caregiver burden are increased when the patient has a calculated life expectancy of &lt;6 months. These results suggest targets for future supportive care interventions to improve caregiver wellbeing in Latin American and Hispanic populations.
Implementation of an innovative multidisciplinary survivorship clinic: The OWLS (Oncology, Wellness, Lifestyle and Survivorship) experience.
Authors: Christine Mary Duffy, Camille Higel-Mcgovern, Don S. Dizon
Journal: Journal of Clinical Oncology (2022)

34 Background: Cancer survivors have complex medical and psychosocial needs and report difficulty accessing specialty care for short and long-term effects of treatment. We created an innovative multi-specialty survivorship clinic to address the medical and psychosocial consequences of cancer and to promote wellness and healthy lifestyle changes. Methods: The “Oncology, Wellness, Lifestyle and Survivorship” (OWLS) clinic was implemented 12/2020 for breast and gyn cancer survivors and extended to all cancer types in 111/2021. Patients complete pre and post-clinic survey to their medical and psychosocial concerns. OWLS is led by an internist and NP expert in survivorship with nurse navigator, physical activity coach, massage therapist on-site. A multidisciplinary team of providers experienced in survivorship care from hem/onc, cardiology, pulmonary, rheumatology, nephrology, dermatology, endocrinology, neurology, psychiatry, sexual health, physical therapy, nutrition, and lifestyle medicine meet monthly to create a comprehensive care management plan presented to survivors at their follow up visit and shared with their PCP and oncologist. Results: The OWLS team has seen 91 patients as of May 2022 and had 12 MDC meetings. Mean survivor age was 50 and the majority were white (80%) had breast cancer(76%) with non-metastatic disease 80%. Most frequent referrals were nutrition, physical therapy, gastroenterology and sexual health. At 6 mos f/u survey almost all were v.satisfied/satisfied with care. All OWLS MDC providers rated it as valuable. Conclusions: The OWLS clinic is an innovate, multi-specialty program that provides a comprehensive survivorship plan for cancer survivors at any stage of their disease. Areas for future growth include extending onsite services, expanding the number of male survivors serviced, and increasing outreach to non-white, non-commercially insured patients.[Table: see text]
What is the prognostic value of lymph node yield on the outcomes of patients with oral cavity squamous cell carcinoma?
Authors: Carlos Khalil, Mark Khoury, Rui Fu, Danny Enepekides, Kevin Higgins, Irene Karam, Andrew Bayley, Ian Poon, Tra Truong, Zain Ali Husain, Antoine Eskander
Journal: Journal of Clinical Oncology (2022)

330 Background: Lymph node metastases are associated with poor prognosis in oral cavity squamous cell carcinoma (OCSCC). In colorectal, lung, and gastric cancers, the number of lymph nodes removed during primary surgery, lymph node yield (LNY), is an established quality indicator that links with patient survival. As such, clinical guidelines have included a minimum (18) number of nodes to be resected, despite a lack of statistical evidence that supports such a LNY threshold. Currently, this kind of recommendation does not exist for OCSCC. Here, we used a novel single-centre dataset to evaluate the prognostic capacity of LNY on regional failure, locoregional recurrence and disease-free survival (DFS) in patients with OCSCC treated by primary neck surgery. Methods: This retrospective cohort study took place at Sunnybrook Hospital in Toronto, Canada and involved chart review data of all adult patients with treatment-naive OCSCC undergoing primary neck dissection. For each outcome, we first used the maximally selected rank statistics and a bias-corrected C-index to identify an optimal threshold of LNY, and then used a multivariable Cox proportional hazards model to assess the association between high LNY (&gt; threshold) and each outcome. Results: Among the 579 OCSCC patients receiving primary neck dissection, 61.7% (n = 357) were male with mean age of 62.9 years (SD: 13.1) at cancer diagnosis. When adjusting for sociodemographic and clinical factors, LNY &gt; 15 was significantly associated with improved DFS (adjusted HR [aHR]: 0.73, 95% CI: 0.54-0.98) and locoregional control (aHR: 0.68, 95% CI: 0.49-0.95), while LNY &gt; 11 was associated with better regional control (aHR: 0.45, 95% CI: 0.26-0.76). Conclusions: Our study findings suggested high LNY to be a strong independent predictor of various patient-level quality of surgical care metrics. The optimal LNY we found (15 or 11) was lower than the conventionally recommended (18), which calls for further research to establish the validity in practice.
Biomarker testing experiences among people with lung, colorectal, and breast cancer.
Authors: Erica E. Fortune, M Claire Saxton, Alexandra Katherine Zaleta
Journal: Journal of Clinical Oncology (2022)

273 Background: Biomarker testing (BT) in oncology is rapidly becoming the standard-of-care across cancer types. There is an established relationship between BT and subsequent prognosis, as well as patient-reported outcomes; thus, the barriers and facilitators for BT are essential to understand. This study investigated the utilization of BT among people diagnosed with cancer and the most frequently experienced BT problems, as well as the person- and systems-level factors associated with BT problems. Methods: We conducted an online survey with adults ( N= 436) diagnosed with either lung (38%), colorectal (35%) or breast cancer (27%) since 2018 (Mean yrs since diagnosis = 2.6, SD= 1.0), across all cancer stages (35% metastatic at diagnosis) and status (31% initial occurrence; 32% recurrence; 28% remission/no current evidence of disease). Participants (68% women; Mean age = 49yrs, SD= 13; 74% Non-Hispanic White) were recruited through a research panel and cancer advocacy organizations. Results: The majority of respondents (85%) reported undergoing BT as part of their cancer care experience. Among those tested, 37% reported experiencing 0 problems with BT, 42% reported 1-2 problems, 15% reported 3-4, and 6% reported 5-7 ( M= 1.4 problems, SD= 1.5). The most commonly cited BT problems were: difficulty understanding results (28%), l ong wait period between test and results (27%), and difficulty scheduling the test (23%). Key sociodemographic (age, gender, income), clinical (cancer diagnosis), and health system variables (insurance type, care setting) were identified as significant bivariate correlates of the number of BT problems experienced. When considering the variables concurrently in a backwards elimination linear regression model (criterion: Probability of F-to-remove &gt; =.10), 5 variables remain in the model explaining 14% of the overall variance, but only 2 variables hold as significant predictors: having Medicaid significantly increased the number of BT problems ( β=.29, p&lt;.001), while receiving care at an academic/comprehensive care center significantly decreased the number of BT problems ( β= -.13, p&lt;.05). Conclusions: The prevalence of BT in our current sample was high, especially compared to rates reported in the existing literature. While this is a promising finding, as is the low overall number of BT problems reported, patients’ experience of problems varied; opportunities exist to better support patient understanding of results and testing system delivery (wait time, scheduling). Further, patients with Medicaid and those receiving care outside academic/comprehensive care centers were statistically more likely to report problems, even after controlling for key sociodemographic and clinical variables. As the science of BT continues to evolve and become a cornerstone for cancer care, it is imperative that we continue to address equitable access to BT as well as commonly cited BT problems.
Advance directives among patients with advanced cancer in Mexico.
Authors: Yanin Chavarri Guerra, Wendy Alicia Ramos-Lopez, Sofía Sánchez-Román, Paulina Quiroz, Alfredo Covarrubias-Gómez, Natasha Alcocer, Andrea Morales Alfaro, María Reneé Jiménez Sotomayor, Roberto Gonzalez Salazar, Araceli Carrillo Bedoya, Ariana Michael Jimenez Cruz, Monica Carrillo, Karen Eloisa Garcia Dominguez, Aimee Cristina Madariaga Cobos, Montserrat Amaya Caballero, Enrique Soto Pérez de Celis
Journal: Journal of Clinical Oncology (2022)

186 Background: Completion of advance directives can help to ensure consistency with people´s preferences at the end of life. However, disparities in access to advance care planning is common among Hispanic population and little is known about their end-of life wishes. Although in Mexico, advance directives were legalized in 2008, only 21% of people know about it. Objective: To describe end-of-life wishes among patients with advanced cancer planning in a third level hospital in Mexico City. Methods: We conducted a cross-sectional analysis of advance directives planning from patients with advanced cancer included in a multidisciplinary patient navigator-led supportive care program in Mexico City (Te Acompañamos). Patients with a life expectancy of 6 months or less were invited to complete advance directives (AD). Life expectancy was calculated using the palliative performance scale (PPS). Descriptive statistics were used for this analysis. Results: From September 2017 to November 2021, a total of 238 patients were invited to complete AD and 55 (23.1%) completed it, 14.5% in 2017, 29% in 2018, 34.5% in 2019, 9% in 2020 and 12.7% in 2021. The mean age among those who completed AD was 65.8 years (range 38-91), 52.7% were women and 61.8% had gastrointestinal cancer. Forty-three (78.1%) patients stated their wish to die at home, 18.1% to have cardiopulmonary reanimation, 9% invasive mechanical ventilation, 24.4% tube feeding, 90.9% pain medications, 10.9% organ donation, 40% cremation, 38.1% a funeral and 50.9% a death ritual. At median follow up of 5 months (0-39), 43 (78.1%) patients have died, and their endo-of-life wishes were respected in 77.5 % of them concerning the place of death and in 96.7% regarding cardiopulmonary reanimation and invasive mechanical ventilation. Conclusions: In our patient navigator-led supportive program approximately a quarter of patients with advanced cancer and a life expectancy of 6 month or less completed AD and end-of-life wishes were respected in a significant proportion of them. Telemedicine methods used to invite patients during COVID-19 pandemic decreased the proportion of AD completion. Although, advanced care planning is associated with improved in quality of care at the end of life, several barriers and disparities exist among Hispanics and strategies to improve their completion are needed.